Healthcare Organization Staff

Zero Suicide Evaluation

Documents and Forms

Document Name Document Type
Form Training Utilizati Healthcare Organization Staff Form and Instruction
Training Utilizati Training Utilization and Preservation 6/12 month Att I. Training Utilization and Preservation.docx Form and Instruction
Training Utilizati Training Utilization and Preservation Baseline Att H. Training Utilization and Preservation Baseline.docx Form and Instruction
Key Informant Inte Key Informant Interview Case Study Att D. Key Informant Interview Guide_OMB_clean.docx Form and Instruction
Workforce Survey Workforce Survey Att F. Workforce Survey_OMB_clean.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Healthcare Organization Staff	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Training Utilization and Preservation 6/12 month	Training Utilization and Preservation 6/12 month	Att I. Training Utilization and Preservation.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Training Utilization and Preservation Baseline	Training Utilization and Preservation Baseline	Att H. Training Utilization and Preservation Baseline.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Key Informant Interview Case Study	Key Informant Interview Case Study	Att D. Key Informant Interview Guide_OMB_clean.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Workforce Survey	Workforce Survey	Att F. Workforce Survey_OMB_clean.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: GLS National Outcomes Evaluation Suicide Prevention Data Center	FR Citation: 75 FR 28264

Number of Respondents: 13,202	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	66,010	66,010
Annual IC Time Burden (Hours)	17,163	17,163
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.